Osteopenia Is Associated with Inferior Survival After Deceased-Donor Liver Transplantation

Background: Alterations in body composition have been linked to both perioperative and long-term outcomes that cause orthotopic liver transplantation (OLT). Nevertheless, the potential predictive role of recipient bone mineral density (BMD) in clinical outcomes following OLT remains uncertain. In this study, we aimed to explore the role of BMD as a prognostic factor in patients undergoing OLT after brain death donation, in the context of long-term outcome. Methods: A total of 480 patients who underwent OLT during the period from 2010 to 2023 at the University Hospital RWTH Aachen were included in the retrospective analysis. Preoperative computed tomography-based segmentation was used to measure BMD at the level of the 11th thoracic vertebra. Osteopenia was defined based previously described sex-specific cutoffs. Perioperative complications were assessed by Clavien–Dindo (CD) classification and comprehensive complication index (CCI). Survival was analyzed using Kaplan–Meier estimates and uni- and multivariable Cox regression. Results: In our cohort, osteopenia was highly prevalent (48%). Patients with osteopenia exhibited significantly inferior overall survival (log-rank p < 0.001, observed median follow-up 52 months [14–97] vs. 59 months [18–101]) and impaired graft survival (log-rank p = 0.037, observed median follow-up 50 months [13–97] vs. 52 months [14–96]). In our multivariable model, osteopenia was confirmed as an independent risk-factor for inferior overall survival (HR 1.602, 95% CI 1.113–2.306; p = 0.011) and inferior graft survival (HR 1.379, 95% CI 1.018–1.870; p = 0.038). Furthermore, patients suffering from osteopenia required more perioperative red blood cell units (8 [4–13] vs. 6 [3–10], p = 0.027). No significant differences in perioperative complications were observed between osteopenic and non-osteopenic patients. Conclusion: The presence of osteopenia may represent an easily assessable marker associated with long-term outcome in patients undergoing OLT after brain death donation, thus underlining the predictive significance of body composition in this context. Further research is warranted to validate these findings.